Obtain a license as a home health agency in California if your company will provide skilled nursing services in the home. A home health agency license is required for new agencies, existing agencies changing ownership or for new branch office locations of existing licensees. The California Department of Public Health (CDPH) is responsible for licensing.
Fill out Form HS200, Licensing and Certification Application for your home health agency. This form requires disclosure of your company's ownership type, business interests and management agreements, as well as detailed information concerning your administrator and director of nursing. Provide projected expenses for the first 90 days and bank statements.
Complete Form HS 215A, Applicant Individual Information. Include resumes from the administrator, officers, partners or members of the organization. Each person must disclose all current and previous relationships with other health care facilities. Anyone with an interest in the company of 5 percent or more must be identified. Each person must disclose any current or past relationships with other health facilities.
Fill out Form HS 309, Administration and Organizational Structure for your home health agency. You must include copies of all corporate or partnership filings, limited liability company (LLC) documents, partnership agreements, copies of by-laws, and identification of members of any board of directors and board officers. You also must provide certificates of good standing for the organization from the California Secretary of State.
File all forms required relating to criminal history and investigations. Complete Form HS 322, Transmittal Application for Criminal Background Investigation; Form CDPH 325, Criminal Record Clearance Submissions; and Form BCII 8016, Request for Live Scan Service and submit them to the California Department of Justice. This must be completed for each of the company's owners and interest holders.
Fill out Form HS609, Bed or Service Request. Use this form to list all services to be provided by the home health agency.
California does not regulate home health agencies that provide non-medical services. The California Association for Health Care Services at Home provides advice and direction for such companies.
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